Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis

Diabetes dalam kehamilan perlu penanganan untuk mengurangi risiko komplikasi perinatal.

BMJ 340:c1395, 1 April 2010 © Horvath et al 2010
Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. Karl Horvath, Klaus Koch, Klaus Jeitler, et al. 

Objective To summarise the benefits and harms of treatments for women with gestational diabetes mellitus.

Design Systematic review and meta-analysis of randomised controlled trials.

Data sources Embase, Medline, AMED, BIOSIS, CCMed, CDMS, CDSR,CENTRAL, CINAHL, DARE, HTA, NHS EED, Heclinet, SciSearch, severalpublishers' databases, and reference lists of relevant secondary literature up to October 2009.

Review methods Included studies were randomised controlled trials of specific treatment for gestational diabetes compared with usual care or "intensified" compared with "less intensified" specific treatment.

Results Five randomised controlled trials matched the inclusion criteria for specific versus usual treatment. All studies used a two step approach with a 50 g glucose challenge test or screening for risk factors, or both, and a subsequent 75 g or 100 g oral glucose tolerance test. Meta-analyses did not show significant differences for most single end points judged to be of directclinical importance. In women specifically treated for gestational diabetes, shoulder dystocia was significantly less common (odds ratio 0.40, 95% confidence interval 0.21 to 0.75), and one randomised controlled trial reported a significant reduction of pre-eclampsia (2.5 v 5.5%, P=0.02). For the surrogate end point of large for gestational age infants, the odds ratio was 0.48 (0.38 to 0.62). In the 13 randomised controlled trials of different intensities of specific treatments, meta-analysis showed a significant reduction of shoulder dystocia in women with more intensive treatment (0.31, 0.14 to 0.70).

Conclusions Treatment for gestational diabetes, consisting of treatment to lower blood glucose concentration alone or with special obstetric care, seems to lower the risk for some perinatal complications. Decisions regarding treatment should take into account that the evidence of benefit is derived from trials for which women were selected with a two step strategy (glucose challenge test/screening for risk factors and oral glucose tolerance test).

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Salam sehat,
Dr. David Fadjar Putra, MS
Spesialis Gizi Klinik
@
www.kliniknutrisi.com
kliniknutrisi.blogspot.com

Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene

Defisiensi vitamin D sering terjadi pada COPD, dan berhubungan dengan beratnya serangan.

Dianjurkan pemberian suplemen vitamin D pada penderita COPD berat, terutama bagi penderita dengan varian gen rs7041.

Thorax 65:215-220, March 2010 © 2010 BMJ Publishing Group Ltd & British Thoracic Society
Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene. Wim Janssens, Roger Bouillon, Bart Claes, et al. 

Abstract

Introduction Vitamin D deficiency has been associated with many chronic illnesses, but little is known about its relationship with chronic obstructive pulmonary disease (COPD).

Objectives Serum 25-hydroxyvitamin D (25-OHD) levels were measured in 414 (ex)-smokers older than 50 years and the link between vitamin D status and presence of COPD was assessed. The rs7041 and rs4588 variants in the vitamin D-binding gene (GC) were genotyped and their effects on 25-OHD levels were tested.

Results In patients with COPD, 25-OHD levels correlated significantly with forced expiratory volume in 1 s (FEV₁) (r=0.28, p<0.0001). Compared with 31% of the smokers with normal lung function, as many as 60% and 77% of patients with GOLD (Global Initiative for Obstructive Lung Disease) stage 3 and 4 exhibited deficient 25-OHD levels <20 ng/ml (p<0.0001). Additionally, 25-OHD levels were reduced by 25% in homozygous carriers of the rs7041 at-risk T allele (p<0.0001). This correlation was found to be independent of COPD severity, smoking history, age, gender, body mass index, corticosteroid intake, seasonal variation and rs4588 (p<0.0001). Notably, 76% and 100% of patients with GOLD stage 3 and 4 homozygous for the rs7041 T allele exhibited 25-OHD levels <20 ng/ml. Logistic regression corrected for age, gender and smoking history further revealed that homozygous carriers of the rs7041 T allele exhibited an increased risk for COPD (OR 2.11; 95% CI 1.20 to 3.71; p=0.009).

Conclusion Vitamin D deficiency occurs frequently in COPD and correlates with severity of COPD. The data warrant vitamin D supplementation in patients with severe COPD, especially in those carrying at-risk rs7041 variants.

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Salam sehat,
Dr. David Fadjar Putra, MS
Spesialis Gizi Klinik
@
www.kliniknutrisi.com
kliniknutrisi.blogspot.com

Apakah statin dapat menurunkan tekanan darah ?

Apakah pemberian preparat statin dapat menurunkan tekanan darah ?

Penelitian dari berikut ini tidak mendapatkan efek penurunan tekanan darah dari pemberian statin.

BMJ 340: c1197, 25 March 2010 © 2010 Mancia et al.
Statins, antihypertensive treatment, and blood pressure control in clinic and over 24 hours: evidence from PHYLLIS randomised double blind trial. Giuseppe Mancia, Gianfranco Parati, Miriam Revera, et al. 

Objective To investigate the possibility that statins reduce blood pressure as well as cholesterol concentrations through clinic and 24 hour ambulatory blood pressure monitoring.

Design Randomised placebo controlled double blind trial.

Setting 13 hospitals in Italy

Participants 508 patients with mild hypertension and hypercholesterolaemia,aged 45 to 70 years.

Intervention Participants were randomised to antihypertensive treatment (hydrochlorothiazide 25 mg once daily or fosinopril 20 mg once daily) with or without the addition of a statin (pravastatin 40 mg once daily).

Main outcome measures Clinic and ambulatory blood pressure measuredevery year throughout an average 2.6 year treatment period.

Results Both the group receiving antihypertensive treatment without pravastatin (n=254) (with little change in total cholesterol) and the group receiving antihypertensive treatment with pravastatin (n=253) (with marked and sustained reduction in total cholesterol and low density lipoprotein cholesterol) had a clear cut sustained reduction in clinic measured systolic and diastolic blood pressure as well as in 24 hour, and day and night, systolic and diastolic blood pressure. Pravastatin performed slightly worse than placebo, and between group differences did not exceed 1.9 (95% confidenceinterval –0.6 to 4.3, P=0.13) mm Hg throughout the treatment period. This was also the case when participants who remained on monotherapy with hydrochlorothiazide or fosinopril throughout the study were considered separately.

Conclusions Administration of a statin in hypertensive patients in whom blood pressure is effectively reduced by concomitant antihypertensive treatment does not have an additional blood pressure lowering effect.

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Salam sehat,
Dr. David Fadjar Putra, MS
Spesialis Gizi Klinik
@
www.kliniknutrisi.com
kliniknutrisi.blogspot.com